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The Timing of Surgery for Congenital Diaphragmatic Hernia in Infants, on or after Weaning from Extracorporeal Membrane Oxygenation: A Meta-Analysis
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Read the article on dx.doi.org ↗Article · Jan 2024 · 1 min read
In brief
In brief
Meta-analysis comparing surgical timing for CDH repair in ECMO-supported infants demonstrates that delaying surgery until after ECMO weaning significantly reduces mortality and postoperative bleeding complications. Evidence supports post-weaning repair as the preferred approach for hemodynamically unstable neonates requiring ECMO support.
- Surgery after ECMO weaning reduces mortality by 58% compared to surgery while still on ECMO (OR 2.40, p=0.01)
- Delaying CDH repair until after ECMO discontinuation significantly decreases postoperative bleeding risk (OR 16.20)
- Meta-analysis supports stabilization and ECMO weaning before surgical intervention in CDH infants requiring ECMO
- Timing of surgery impacts survival outcomes; waiting for hemodynamic stability improves perioperative safety
Written by the GCMD Library team from the article.
Objectives We conducted a meta-analysis of trials to determine the optimal time to conduct surgery for congenital diaphragmatic hernia (CDH) in infants, on or after weaning from extracorporeal membrane oxygenation (ECMO). Methods We searched the PubMed, Embase, Scopus, and Cochrane Library databases to identify relevant articles published prior to May 2023 in which surgery was performed to treat CDH in infants. Data were collected, and continuous data were represented by the mean difference (MD) and 95% confidence interval (CI). Dichotomous data were represented by the odds ratio (OR) and 95% CI. Review Manager V.5.4 and Stata were used to synthesize results and to assess publication bias. Results The results showed that infants undergoing surgery after being weaned from ECMO had reduced mortality (OR, 2.40; 95% CI, 1.23–4.69; p = 0.01) and postoperative bleeding rates (OR, 16.20; 95% CI, 5.73–45.76; p
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